Original Research

The State of Hepatitis C Care in the VA

Primary care providers are increasingly important in the treatment of patients with the hepatitis C virus, especially for the large cohort of veterans born between 1945 and 1965.

Fed Pract. 2015 February;32(suppl 2):20S-24S

Author(s):

References

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As the largest single provider of hepatitis C virus infection (HCV) care in the U.S., the VA provided care to > 174,000 veterans with chronic HCV in 2013. Identifying veterans most likely to be infected with HCV, particularly those in the highrisk birth cohort born between 1945 and 1965, is a priority given recent CDC and U.S. Preventive Services Task Force (USPSTF) recommendations. ^1,2 The availability of new, all-oral HCV antiviral regimens with shorter treatment durations and improved tolerability are expected to greatly increase the number of veterans with HCV who could be treated successfully. In order to effectively reach those who are undiagnosed and to ensure that those diagnosed with HCV are evaluated and offered treatment, expanded reliance on primary care providers (PCPs) is essential. This article provides a population view of the current state of VA care for this large HCV-infected population and the important role PCPs share in disease identification and management.

Data Source

Data regarding the state of HCV care in the VA comes from the VA National Clinical Case Registry (CCR) for HCV. ³ The VA HCV CCR is an extract of the VA electronic medical record that contains laboratory results, pharmacy information, provider information, and ICD-9 diagnosis codes from inpatient hospitalizations, outpatient visits, and problem lists of veterans with HCV seen at all VAMCs.

Screening and Prevalence of HCV

It is estimated that 2.3 to 2.7 million Americans are living with HCV, with 45% to 85% of those unaware of their infection. ^4,5 Nearly 75% of those infected are expected to have been born between 1945 and 1965; thus, the CDC and USPSTF now recommend onetime HCV screening for this birth cohort. ^1,2 Among nearly 5.6 million veterans with a VA outpatient visit in 2013, 56% have been screened for HCV. The HCV screening rate was 42% for those born prior to 1945, 65% for those born during 1945-1965, and 59% for those born after 1965. HCV infection prevalence overall in the VA was 5.8% but differed markedly among the birth cohorts: 1.6% for those born prior to 1945, 9.5% for those born during 1945-1965, and 1.2% for those born after 1965. The prevalence rate of veterans born in the 1945-1965 birth cohort (9.5%) is almost 3 times higher than that of the general U.S. population in this birth cohort (2.4%). The high prevalence serves as a reminder of the greater HCV disease burden in veterans and largely represents Vietman era veterans. Although HCV screening rates in VA have increased over 25% since 2002, the high prevalence among veterans in this birth cohort underscores the importance of continued screening efforts.

Veterans with Chronic HCV Infection

The VA Office of Public Health/Population Health generates national HCV reports annually from the HCV CCR describing the population of veterans with chronic HCV infection receiving VA care. These reports are intended to inform about patient care activities, clinician and patient education, prevention activities, and research directed at continuous improvement of veteran care. The first step in providing responsive care is understanding the affected population, and summarized herein is a description of the veterans with chronic HCV who received VA care in 2013.